Prevalence and prognosis of cor pulmonale during protective ventilation for acute respiratory distress syndrome

Purpose Pulmonary vascular dysfunction is common during acute respiratory distress syndrome (ARDS), but there is controversy concerning prevalence and prognosis of cor pulmonale during protective ventilation for ARDS. Methods This was a prospective observational study in an academic medical intensiv...

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Vydáno v:Intensive care medicine Ročník 39; číslo 10; s. 1725 - 1733
Hlavní autoři: Boissier, Florence, Katsahian, Sandrine, Razazi, Keyvan, Thille, Arnaud W., Roche-Campo, Ferran, Leon, Rusel, Vivier, Emmanuel, Brochard, Laurent, Vieillard-Baron, Antoine, Brun-Buisson, Christian, Mekontso Dessap, Armand
Médium: Journal Article
Jazyk:angličtina
Vydáno: Berlin/Heidelberg Springer Berlin Heidelberg 01.10.2013
Springer Nature B.V
Témata:
Anesthesiology
Cor pulmonale
Critical Care Medicine
Echocardiography, Transesophageal
Emergency Medicine
Female
France - epidemiology
Hospital Mortality
Hospitals
Humans
Intensive
Intensive care
Kaplan-Meier Estimate
Logistic Models
Male
Medicine
Medicine & Public Health
Middle Aged
Mortality
Nitric oxide
Original
Pain Medicine
Patient positioning
Pediatrics
Pneumology/Respiratory System
Pneumonia
Prevalence
Prognosis
Prospective Studies
Pulmonary Heart Disease - diagnosis
Pulmonary Heart Disease - epidemiology
Pulmonary Heart Disease - etiology
Regression analysis
Respiration, Artificial - adverse effects
Respiration, Artificial - methods
Respiration, Artificial - statistics & numerical data
Respiratory distress syndrome
Respiratory Distress Syndrome - complications
Respiratory Distress Syndrome - mortality
Respiratory Distress Syndrome - therapy
Risk Assessment - methods
Sepsis
Ventilators
France
Germany, Berlin
Acute lung injury
Echocardiography
Mechanical ventilation
Right ventricle
ISSN:0342-4642, 1432-1238, 1432-1238
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Shrnutí:Purpose Pulmonary vascular dysfunction is common during acute respiratory distress syndrome (ARDS), but there is controversy concerning prevalence and prognosis of cor pulmonale during protective ventilation for ARDS. Methods This was a prospective observational study in an academic medical intensive care unit in France. Two hundred and twenty-six consecutive patients with moderate to severe ARDS (Berlin definition) ventilated with plateau pressure limited at 30 cmH 2 O (mean PEEP of 8.8 ± 3.6 cmH 2 O) underwent transesophageal echocardiography (TEE) within the first 3 days after the diagnosis of ARDS. Cor pulmonale was defined as a dilated right ventricle associated with septal dyskinesia. Results Cor pulmonale was detected in 49 patients (prevalence of 22 %; 95 % confidence interval, 16–27 %). Multivariate logistic regression identified infectious causes of lung injury and higher driving pressures as independent factors associated with cor pulmonale. Patients with cor pulmonale exhibited a higher incidence of shock (need for vasoactive drug) at the time of TEE and were more often managed with prone positioning and/or nitric oxide as adjunctive therapy for severe hypoxemia during ARDS course. The 28-day mortality rate was significantly higher in the group with cor pulmonale (60 vs. 36 %, p  < 0.01). Multivariate logistic regression identified McCabe and Jackson class, lung injury not related to pneumonia, aspiration, or sepsis, lactic acidosis, driving pressure, and cor pulmonale as independent risk factors for 28-day mortality. Conclusion Cor pulmonale occurrence is not negligible in ARDS patients ventilated with airway pressure limitation. Cor pulmonale was associated with sepsis and higher values of driving pressure and was an independent risk factor for 28-day mortality in our series.
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ISSN:0342-4642
1432-1238
1432-1238
DOI:10.1007/s00134-013-2941-9